Using mitral 'annulus reversus' to diagnose constrictive pericarditis.
OBJECTIVE
To characterize mitral medial and lateral annular velocities in constrictive pericarditis or restrictive cardiomyopathy compared with normal subjects.


RESULTS
Tissue Doppler imaging peak systolic velocity (S'), peak early diastolic annular velocity (e'), and timing difference between mitral early flow and early annular movement were measured in 14 patients with constrictive pericarditis, 10 with restrictive cardiomyopathy, and 17 normal subjects using the apical four-chamber view lateral and medial mitral annulus. In controls, mitral lateral e' velocity was 25% higher than medial e' velocity (13.0 +/- 3.1 vs. 10.7 +/- 2.8 cm/s; P = 0.02), whereas with constrictive pericarditis, averaged lateral e' velocity was 2% lower than medial e' velocity (10.7 +/- 2.5 vs. 11.2 +/- 3.1 cm/s; P > 0.05). This relationship represented a reversal of lateral and medial e' velocities compared with normal subjects (P = 0.004). Differences in S', E/e', and timing intervals between normal subjects and patients with constrictive pericarditis were not statistically significant; however, restrictive cardiomyopathy could be distinguished from constrictive pericarditis and controls with all other parameters (S', E/e', medial and lateral e' velocities, and timing interval differences; all P < 0.05).


CONCLUSIONS
Practical applications of tissue Doppler imaging for evaluation of possible constrictive pericarditis include reversal of the relationship between lateral and medial e' velocities (i.e. 'annulus reversus').
Reuss
Christina S
CS
Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, USA.
Wilansky
Susan M
SM
Lester
Steven J
SJ
Lusk
Joan L
JL
Grill
Diane E
DE
Oh
Jae K
JK
Tajik
A Jamil
AJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000686:Amyloidosis / Q000150:complications; D001783:Blood Flow Velocity; D002313:Cardiomyopathy, Restrictive / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D003937:Diagnosis, Differential; D015150:Echocardiography, Doppler / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging* / Q000503:physiopathology; D010494:Pericarditis, Constrictive / Q000000981:diagnostic imaging* / Q000503:physiopathology